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   Table of Contents - Current issue
October-December 2018
Volume 26 | Issue 4
Page Nos. 139-186

Online since Monday, September 24, 2018

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The Turkish journal of plastic surgery: Past and present p. 139
Cenk Demirdover
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A new technique in fingertip defects including nail lost: Reverse dorsal fascial flap with skin graft p. 140
Bulent Ozcelik, Bilsev Ince
Background/Aim: Many different flaps described in the reconstruction of fingertip amputations may not provide optimal esthetic appearance due to hyponychial tissue loss and the lack of volar support of the nail bed. Except for free nail transfer and composite graft, the number of techniques described for nail reconstruction of the finger is limited. We aimed to investigate the utility of the reverse dorsal facial flap and to determine satisfaction rate of the esthetic and functional results obtained. Patients and Methods: Sixteen patients who were referred due to fingertip amputation including loss of nail bed between 2014 and 2017 and who could not be replanted were prospectively included. Flap planning was made from the proximal part of the nail bed toward the middle phalanx depending on the defect size. The skin was harvested superficially to the lateral side and kept on the fascial layer at the bottom. A fascial flap was harvested by preserving the paratenon. The flap was transposed, and the reconstructed area of the nail bed or defect of the nail bed was closed. A full-thickness skin graft was applied over the fascia. Results: There was no total flap loss or partial necrosis in any patient. None of the patients had complications that would require a second flap surgery. The mean Visual Analog Scale score of the patients control was 1.06. The calculated Disabilities of Arm, Shoulder, Hand score was 3.08. The mean Likert score of the patients was 17. Conclusion: The dorsal fascial flap can be applied as an alternative surgical method in patients with fingertip defects including nail loss or damage in order to provide esthetically favorable nail appearance.
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The determination of the effect of curcumin on autologous fat graft survival in rats: Experimental study p. 144
Mahmut Ozgul, Yakup Karabagli, Atacan Emre Kocman, Ayse Aydan Kose, Cengiz Cetin, Dilek Burukoglu Donmez
Introduction: Curcumin, extracted from the roots of plant Curcuma longa, had been widely used in eastern medicine for centuries for the treatment of infections and pain management. It is vastly studied in modern medicine in the last two decades. In oncology, it is studied for its anticarcinogenic properties also to reduce the toxicity of chemotherapeutics, in diabetes to treat microvascular complications and wound healing management, and in ophthalmology for inflammatory diseases, and its therapeutic efficiency has been shown. Material and Method: In this study, 80 Wistar Albino rats' (female) inguinal fat pads excised, weight, and volume measures recorded and put under the scalp flap as en bloc fat grafts. Rats grouped in four such as control (Group 1), oral curcumin (Group 2), topical curcumin (Group 3), and oral + topical curcumin (Group 4), and at the days 1st, 4th, 7th, and 14th, two rats from each group were sacrificed, grafts extracted, and stained with perilipin for immunohistochemical and hematoxylin-eosin for histological examination. At the day 98th, all groups were sacrificed, fat grafts extracted, weight and volume differences recorded, and same histologic and immunohistochemical stains applied. Results: Topical curcumin applied groups' (Group 3 and Group 4) weight and volume “percent change” was statistically significant lower than groups which curcumin not topically applied (Group 1 and Group 2) (P < 0.05, P = 0.062). Early biopsies' histological and immunohistochemical examinations show that topically curcumin applied groups have more adipocytes that maintain their normal shape and better neovascularization of graft, however, less tissue cellular infiltration, hemorrhagic, and cyst and vacuole formation. Conclusion: Topically applied curcumin on fat grafts increased fat graft survival rate.
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Nasolabial flaps for nasal reconstruction: Pros and cons p. 151
Ersin Aksam, Berrak Aksam, Onder Karaaslan, Mustafa Durgun
Background: Nasolabial flaps are one of the most preferred methods for nasal reconstruction. Lots of modifications of nasolabial flaps were defined. V-Y or hatchet type advancement, transposition, subcutaneous pedicled, two-stage interpolation, and propeller types are commonly used. Objective: The objective of the study is to evaluate the nasal reconstructions with nasolabial flaps according to subunits and defining the advantages and disadvantages for each subunit. Patients and Methods: Patients whose nasal defects were reconstructed with nasolabial flaps in the last 5 years were evaluated in this study. Results: Ninety-one patients whose nasal defects were reconstructed with nasolabial flaps were included in this study. V-Y advancement, hatchet type advancement, transposition, subcutaneous pedicled, two-stage interpolation, and propeller type nasolabial flaps were used for reconstruction of defects. The most common complication was trap-door deformity that was followed by alar distortion and venous congestion. Conclusion: V-Y or hatchet type advancement flaps and subcutaneous pedicled type should be preferred for sidewalls and dorsum defects, respectively. Two-stage interpolation type gives the best results for tip region defects. Propeller and transposition type flaps should be the choice of treatment in alar region defects.
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Cleft lip and palate assessment form: Medical history, oral-peripheral characteristics, speech problems p. 156
Ozlem Unal-Logacev, Deniz Kazanoglu, Eren Balo, Ayse Nemutlu
Objective: The objective of the study is to identify the medical histories, oral-peripheral characteristics and speech problems of children with cleft lip and palate (CLP) or craniofacial anomalies, and eventually create an assessment form that highlights the factors that should be taken into consideration in the examination of those children. Materials and Methods: An assessment form was developed and used to assess with a descriptive method the medical history, oral peripheral, speech, and resonance characteristics of children with CLP. The study included 56 (21 females and 35 males) children with CLP. The results are presented as frequency or percentage. Results: About 20% of the CLP patients were offspring of consanguineous marriage and about 30% had positive family history of CLP. The major difficulty families experienced was feeding. Hearing impairment at various degrees was reported in 23% of the participants. The presence of cardiovascular, renal, neurological and endocrinological problems, and symptoms addressed in peripheral examination were identified as critical in discriminating syndromic cases. Assessment of the speech skills showed backing to be the most prevalent error among the participants. Conclusion: The form that was developed in scope of this study was observed to successfully define the medical history, oral-peripheral characteristics and speech problems of individuals with CLP. The form, however, needs further testing in larger populations and comparison to non-CLP populations.
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Regional flaps in maxillofacial and oral soft-tissue reconstruction: Experiences and challenges in a developing country p. 169
Ramat Oyebunmi Braimah, Abdurrazaq Olanrewaju Taiwo, Aremu Adebayo Ibikunle, Micah Olalekan Gbotolorun, Mike Adeyemi, Bala Mujtaba
Background: Maxillofacial and oral defects are complex to reconstruct because of the intricate nature of tissues. The aim of this study is to present our experience in maxillofacial and oral soft-tissue defects reconstruction using regional flaps. Patients and Methods: This is a retrospective study of maxillofacial and oral soft-tissue reconstruction (MFOSTR) in the Department of Dental and Maxillofacial Surgery of a University Teaching Hospital, northwest Nigeria, over a 4 years' period. Data such as age, sex, diagnosis, type of flap used, complications, and prognosis were collected and analyzed with IBM SPSS Statistics for Windows Version 20 (Armonk, NY, USA: IBM Corp). Results: A total of 64 MFOSTRs were performed during the study out of which 22 (34.4%) were done using regional flaps. They consist of 10 (45.5%) males and 12 (54.5%) females, with a male: female ratio of 0.8:1. Cancrum oris (17 [77.3%]) was the main indication for regional flap utilization in the MFOSTR. Deltopectoral flap (18 [81.8%]) was the most commonly used flap in our series. Other flaps used were; pectoralis major 3 (13.6%) and latissimus dorsi 1 (4.5%) flaps. Total flap failure was observed in 3 (13.6%). Conclusion: Despite personnel and infrastructure deficit in developing countries, especially sub-Saharan Africa, maxillofacial and oral reconstruction in our hospital has achieved some success. Patient selection is important for overall flap success.
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A heterotopic digital replantation in an 18-month-old child p. 174
Mehmet Dadaci, Bilsev Ince, Fatma Bilgen, Serhat Yarar
In multiple digital amputations, it is not always possible to replant the same amputated part. In these cases, heterotopic digital replantation is a suitable option in terms of cosmetic and functional outcomes. In our report, we described a heterotopic digital replantation in an 18-month-old male child who had multiple digital amputation as a result of placing his hand in the ventilator. Heterotopic replantation is an important method that should be kept in mind in multiple finger amputations which can enable a good cosmetic and functional result, especially in cases where the stump of the amputated finger is not suitable/veya convenient.
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An unusual cause of unilateral prominent ear: Dermoid cyst p. 177
Alpay Duran
The etiology of ear protrusion is multifactorial and poorly understood. Prominent ear deformities with an autosomal inheritance pattern are found in 5% of caucasian population. However, pathological causes are very rare. The only dermoid cyst case causing prominent ear deformity was reported by Meagher and Morrison in English literature. We present a case of postauricular dermoid cyst causing unilateral prominent ear deformity.
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Secondary breast reduction: Outcome and literature review p. 180
Bilgen Can
Breast reduction surgery that was planned in a patient who had previous breast reduction surgery due to continuation or recurrence of macromastia symptoms after a certain period is called breast rereduction or secondary breast reduction surgery. The reasons that lead to secondary breast reduction surgery include inadequate volume excision at the first operation, pseudoptosis, or recurrence of macromastia. The most important aspect of the secondary breast reduction surgery is to determine the appropriate pedicle technique. In the literature, there are different opinions about the best pedicle technique for secondary reduction mammoplasty. We have planned secondary breast reduction surgery using superior pedicle technique in a patient who developed shoulder and arm pain and recurrent skin rashes under the breasts 13 years after the first operation. We prepared this report to present the outcome of our patient and discuss different surgical approaches for secondary breast reduction surgery with relevant literature.
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Cutaneous mucormycosis in immunocompromised patients due to corticosteroid use p. 185
Mustafa Kursat Evrenos, Merve Ozkaya Unsal, Yavuz Kececi
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